The Strong Heart Study is a study of cardiovascular disease and its risk factors among American Indians. The study involves 13 Indian communities in Arizona, Oklahoma, and the Dakotas. Phases I and II from October 1988 through July 1996, included a community mortality study for individuals 35- 74 years of age who died between 1984 through July 1996, included a community mortality study for individuals 35-74 years of age who died between 1984 and 1994 a baseline physical examination on 4500 individuals 45-74 years of age and a follow-up examination of all living members of th original cohort to measure prevalence of cardiovascular and peripheral vascular disease and known and suspected risk factors. An extension (Phase III) is proposed in which the mortality survey will be continued through 1999, and the cohort of men and women examined during phase I will undergo a re-examination which will include a carotid ultrasound measure and arterial tomography. A pilot family study will be initiated involving 9-00 individuals in 30 extended families. The aims of Phase III are to determine CVD mortality and morbidity rates in the examined cohort by surveillance to determine the change in risk factors over time and the relationship between risk factors and incidence of CVD. Additional aims are to explain the differences in rates of CVD morbidity and mortality between centers to assess risk factors for CVD in individuals with diabetes, and to investigate structural and functional cardiac disease and atherosclerosis using ultrasonography. Additional specific laboratory measurements will be made in a case cohort design on Phase I samples to assess the roles of several potential new risk factors. This application is for the Arizona Field Center and the Core Laboratory and contains a subcontract for the family study for the Strong Heart Study Phase III.